Table 1

Diagnostic criteria for Miller Fisher syndrome, Bickerstaff's brain stem encephalitis, and acute ophthalmoparesis

Features required for diagnosis
Miller Fisher syndrome:
 Progressive, relatively symmetric ophthalmoplegia and ataxia by 4 weeks
 Hyporeflexia or areflexia
 Limb strength with 5 or 4 on the Medical Research Council scale
Bickerstaff's brain stem encephalitis:
 Progressive, relatively symmetric ophthalmoplegia and ataxia by 4 weeks
 Either consciousness disturbance (coma, semicoma, or stupor) or pyramidal signs (hyperreflexia or pathological reflexes)
 Limb strength with 5 or 4 on the Medical Research Council scale
Acute ophthalmoparesis:
 Progressive, relatively symmetric ophthalmoplegia by 4 weeks
 Neither ataxia nor limb weakness
Features strongly supportive of the diagnosis for each condition
A history of infectious symptoms within 4 weeks before the onset of neurological symptoms
CSF albuminocytological dissociation
Presence of anti-GQ1b IgG antibody
Features that rule out the diagnosis
Wernicke's encephalopathy, vascular disease involving the brain stem, multiple sclerosis, neuro-Behçet's disease, botulism, myasthenia gravis, brain stem tumour, pituitary apoplexy, vasculitis, and lymphoma
Appendix
Patients showing limb weakness (3 or less on the Medical Research Council scale), in addition to ophthalmoplegia and ataxia, were diagnosed as having overlapping Miller Fisher syndrome and Guillain-Barré syndrome.
Patients showing limb weakness (⩽3 on the Medical Research Council scale), in addition to consciousness disturbance (coma, semicoma, or stupor) or pyramidal signs as well as ophthalmoplegia, were diagnosed as having overlapping Bickerstaff's brain stem encephalitis and Guillain-Barré syndrome.